Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness

Howell, Kaitlen; Grill, Eva; Klein, Anke-Maria; Straube, Andreas; Bender, Andreas

doi:10.1016/j.resuscitation.2013.05.015

Cited by 92 publications

(72 citation statements)

References 29 publications

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“…26,28 A large fraction of comatose cardiac arrest patients may progress to a vegetative state if intensive care is continued. 29 In our study one patient with absent pupillary light reflexes and one patient with absent corneal reflexes made a good recovery. However, none of the patients with the absence of both pupillary light reflexes and corneal reflexes had good outcome.…”

Section: Discussionsupporting

confidence: 63%

Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C: Results from a randomised controlled clinical trial

et al. 2015

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Section: Discussionsupporting

confidence: 63%

Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C: Results from a randomised controlled clinical trial

et al. 2015

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“…Only one study is available on rehabilitation outcome of hypoxic-ischemic patients [11]. The study enrolled 113 inpatient cases and mainly focused on recovery of consciousness, but not on functional abilities.…”

Section: Introductionmentioning

confidence: 99%

Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation

Heinz

Rollnik

2015

BMC Res Notes

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BackgroundThe prevalence of patients suffering from hypoxic brain damage is increasing. Long-term outcome data and prognostic factors for either poor or good outcome are lacking.MethodsThis retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation [length of stay: 108.5 (81.9) days]. Clinical data, validated outcome scales (e.g. Barthel Index—BI, Early Rehabilitation Index—ERI, Glasgow Coma Scale—GCS, Coma Remission Scale—CRS), neuroimaging data, electroencephalography (EEG) and evoked potentials were analyzed.Results75.3% had a poor outcome (defined as BI <50). 38 (40.9%) patients were discharged to a nursing care facility, 21 (22.6%) to subsequent rehabilitation, 17 (18.3%) returned home, 9 (9.7%) needed further acute-care hospital treatment and 8 (8.6%) died. Barthel Index on admission as well as coma length were strong predictors of outcome from hypoxic brain damage. In addition, duration of vegetative instability, prolongation of wave III in visual evoked potentials (flash VEP), theta and delta rhythm in EEG, ERI, GCS and CRS on admission were related to poor outcome. All patients with bilateral hypodensities of the basal ganglia belonged to the poor outcome group. Age had no independent influence on functional status at discharge.ConclusionsAs with other studies on neurological rehabilitation, functional status on admission turned out to be a strong predictor of outcome from hypoxic brain damage.

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“…Given the widespread practice of WLST at 72 hours, the number of those with potentially good outcomes may still be considerable. The magnitude of the potential number of patients who could achieve good functional status is unclear at this time, but our results indicate that there is room for improvement (41). This study is not designed to determine the optimal time to perform prognostication and WLST post-TH; however, it does suggest that 72 hours is an insufficient amount of time.…”

Section: Discussionmentioning

confidence: 83%

“…Until evidence-based recommendations on when and how to prognosticate neurologic outcomes in patients treated with TH are available, a more conservative approach to WLST may be indicated. It is also worth mentioning that in a recent study by Howell et al (41) carried out at a German neurorehabilitation center, of 113 patients admitted with disorders of consciousness following anoxic-ischemic encephalopathy, as many as 6.2% of patients achieved good functional outcomes (Glasgow Outcome Scale, 4-5) with improvements being noted beginning at 8-12 weeks postanoxic event despite having had initial poor prognostic markers such as somatosensory evoked potentials. Both of these studies highlight our lack of ability to predict functional recovery, the potential for delayed recovery, and the need for further research in this area as indiscriminant delays in WLST will have a significant impact on survivors, their families, and the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Awakening and Withdrawal of Life-Sustaining Treatment in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Mulder

Gibbs

Smith

et al. 2015

Survey of Anesthesiology

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Objectives-To characterize the prevalence of withdrawal of life-sustaining treatment, as well as the time to awakening, short-term neurologic outcomes, and cause of death in comatose survivors of out-of-hospital resuscitated cardiopulmonary arrests treated with therapeutic hypothermia.Design-Single center, prospective observational cohort study of consecutive patients with outof-hospital cardiopulmonary arrests. Setting-Academic HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptPatients-Adults with witnessed, nontraumatic, out-of-hospital cardiopulmonary arrests regardless of initial electrocardiographic rhythm with return of spontaneous circulation who were admitted to an ICU. Interventions-None.Measurements and Main Results-The study cohort included 154 comatose survivors of witnessed out-of-hospital cardiopulmonary arrests who were admitted to an ICU during the 54-month study period. One hundred eighteen patients (77%) were treated with therapeutic hypothermia. The mean age was 59 years, 104 (68%) were men, and 83 (54%) had an initial rhythm of ventricular tachycardia or fibrillation. Only eight of all 78 patients (10%) who died qualified as brain dead; and 81% of all patients (63 of 78) who died did so after withdrawal of lifesustaining treatment. Twenty of 56 comatose survivors (32%) treated with hypothermia who awoke (as defined by Glasgow Motor Score of 6) and had good neurologic outcomes (defined as Cerebral Performance Category 1-2) did so after 72 hours.Conclusions-Our study supports delaying prognostication and withdrawal of life-sustaining treatment to beyond 72 hours in cases treated with therapeutic hypothermia. Larger multicenter prospective studies are needed to better define the most appropriate time frame for prognostication in comatose cardiac arrest survivors treated with therapeutic hypothermia. These data are also consistent with the notion that a majority of out-of-hospital cardiopulmonary arrest survivors die after a decision to withdrawal of life-sustaining treatment and that very few of these survivors progress to brain death. Keywordsbrain death; cardiac arrest; outcome; prognostication; therapeutic hypothermia; withdrawal of lifesustaining treatmentOut-of-hospital cardiopulmonary arrests (OHCA) pose a significant public health burden, with an estimated annual prevalence of over 380,000 arrests evaluated by emergency medical services in the United States alone (1-4). In the decade following the 2002 landmark trials of therapeutic hypothermia (TH) to improve outcomes in comatose cardiac arrest survivors, little additional progress has been made in finding and implementing successful new neuroprotective interventions (5, 6). Therefore, TH remains the only proven neuroprotective strategy available and the focus of the resuscitation community. A number of factors explain this lack of progress: a lack of understanding of the mechanisms and circumstances leading to poor outcomes, lead time and selection biases, as well as funding and ethical co...

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Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness

Cited by 92 publications

References 29 publications

Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C: Results from a randomised controlled clinical trial

Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C: Results from a randomised controlled clinical trial

Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation

Awakening and Withdrawal of Life-Sustaining Treatment in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

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